Maggie Alston
Principal
New York, NY, US
Maggie Alston is a principal based in New York. She joined Milliman in 2015.
Experience
Maggie has an extensive background in healthcare data analytics. She has worked with traditional and nontraditional healthcare data sources to build population identification and bundled payment algorithms, and is an expert in developing dynamic, illustrative data models.
Maggie also has experience in developing shared risk arrangements between payers and providers and between payers and pharmaceutical companies.
Prior to joining Milliman, Maggie worked as a technical lead, developing patient identification and treatment algorithms for a population health technology start-up. Maggie also previously worked for a large medical group in compliance and patient satisfaction analytics.
Publications and Presentations
- A Comparative Retrospective Analysis of Comorbidities Potentially Sensitive to Corticosteroid Exposure between Incident COPD and Overall Medicare Populations. 2021 AMCP Nexus Conference Poster. October 2021. Denver, CO.
- The Complexity of Medicare's Pharmacy Benefit Structure in a Budget Impact Model. 2021 ISPOR Annual Conference Poster. May 2021.
- Treatment patterns for patients with CAR T-indicated lymphoma diagnoses receiving third or later-line therapy. Commissioned by Gilead Sciences, Inc. Published on milliman.com. December 2020.
- Strategic Use of Post-Market Real World Evidence to Demonstrate Value. 2019 MedTech Conference. October 2019. Boston, MA.
- Risk Contracting: A New Path to Partnering with Customers. 2019 IDN Summit and Reverse Expo. September 2019. Phoenix, AZ.
- Applying Machine Learning Techniques to Identify Undiagnosed Patients with Exocrine Pancreatic Insufficiency. Commissioned by AbbVie. Published by Journal of Health Economics and Outcomes Research. February 2019.
- Changing the rebate game: A primer on the HHS proposed rule to shift drug rebates to POS. Published on milliman.com. February 2019.
- Breaking though the hype of real world evidence. Published on milliman.com. January 2019.
- Pharma APMs: A learning curve awaits you, pharma. Commissioned by PhRMA. Published by Managed Care. October 2018.
- Pharma APMs: Can the industry learn to play well with others? Commissioned by PhRMA. Published by Managed Care. September 2018.
- Alternative payment model financial settlements: Preparing for and learning from the process. Published on milliman.com. September 2018.
- A primer on prescription drug rebates: Insights into why rebates are a target for reducing prices. Published on milliman.com. May 2018.
- Serious Contracts Come with Risk, but Alternative Payment Models are Here to Stay. 2018 AMCP Nexus Conference. September 2018. Orlando, FL.
- Pharmaceutical Value-Based Contracting. SOA Health Section Medicaid Subgroup. March 2018.
- Value-Based Contracting for Pharmaceutical and Device Manufacturers. 2017 SOA Annual Meeting. September 2017. Boston, MA.
Professional Designations
- Maggie is a Certified Healthcare Finance Professional with the Healthcare Financial Management Association.
Education
- BA, Public Policy Analysis – Biology, Scripps College
Publications
Read their latest work
Article
The next generation of Medicare bundled payments: Considerations regarding TEAM
03 June 2024 - by Alyssa Pennini, Christopher Murphy, Maggie Alston, Noah Champagne, Pamela M. Pelizzari
The Transforming Episode Accountability Model, Medicare’s new approach for bundled payments, will impact a wide variety of acute care hospitals nationwide.
Article
Shadow bundles: A big opportunity for MSSP and REACH ACOs
13 February 2024 - by Maggie Alston, Noah Champagne, Daniel DiNinno, Emma Kramer, Christopher Murphy
New data for the Medicare Shared Savings Program and ACO REACH models provide opportunities for managing referrals, but ACOs should know the data’s limitations.
Article
A primer on Medicare Part D prescription drug rebates: Insights into the possible impact of the Inflation Reduction Act
29 September 2023 - by Jennifer Carioto, Tushar Makhija, Maggie Alston
We offer a primer on the Medicare Part D prescription drug rebates, with insights into the possible impact of the Inflation Reduction Act.
Article
What are bundled payments and how can they be used by healthcare organizations?
27 March 2023 - by Carol Bazell, Maggie Alston, Pamela M. Pelizzari, Brian A. Sweatman
With the CMS, Medicare Advantage organizations, Medicaid organizations, and health plans experimenting with bundled payments, we offer a primer and perspectives.
Article
A 4-year retrospective claims analysis of oral corticosteroid use and health conditions in newly diagnosed Medicare FFS patients with COPD
17 October 2022 - by Bruce S. Pyenson, Melissa A. Caplen, Carol Bazell, Dane Hansen, Maggie Alston, Michael Pollack, Alejandro P Comellas, Sanjay Sethi, Anthony Staresinic, John Styczynski, Norbert Feigler
Using systemic oral corticosteroid (OCS) in treatment of chronic obstructive pulmonary disease (COPD) has risks, highlighting the need for prevention and therapy.
Article
Treatment patterns for patients with CAR T-indicated lymphoma diagnoses receiving third or later-line therapy
02 December 2020 - by Maggie Alston, Carol Bazell, Melissa A. Caplen, Mila Shapoval, Annaliese Mugele
Milliman performed a detailed descriptive analysis to identify the characteristics and treatment patterns of potentially chimeric antigen receptor T-cell therapy eligible adult relapsed/refractory disease B-cell lymphoma patients covered by commercial insurance or Medicare fee-for-service.
Article
Applying machine learning techniques to identify undiagnosed patients with exocrine pancreatic insufficiency
14 February 2019 - by Maggie Alston, Bruce S. Pyenson
This study develops a machine learning model that identifies patients in a commercial medical claims database who likely have exocrine pancreatic insufficiency but are underdiagnosed.
Article
Changing the rebate game: A primer on the HHS proposed rule to shift drug rebates to POS
08 February 2019 - by Maggie Alston, Carol Bazell, David R. Mike
This paper discusses the implications of recently proposed rebate regulation to various Medicare Part D program stakeholders.
Article
Breaking through the hype of real-world evidence
17 January 2019 - by Maggie Alston, Carol Bazell, Christine Ferro, Jocelyn Lau
This paper discusses the expanding use of real-world evidence in healthcare decision-making, as well as the importance of clean and reliable data, robust disease identification algorithms, consistent patient attribution methodologies, and relevant outcomes metrics that can be generated from reliably reported data.
Article
Pharma APMs: A learning curve awaits you, pharma
02 October 2018 - by Maggie Alston, Bruce S. Pyenson
There are some valuable lessons for pharmaceutical manufacturers in provider alternative payment models (APMs), but whether pharmaceutical APMs succeed or fail will depend on finding solutions to operational and logistical challenges—some of which are unique to the pharmaceutical industry.